血浆与红细胞不同的输注比例对急性上消化道出血患者预后的影响

Comparison of the Effect of bBood Transfusion of the Different Ratio of Plasma and Red Blood Cells on the Prognosis of Patients with Acute Upper Gastrointestinal Bleeding

【目的】探讨急性上消化道出血患者输血时血浆（FFP）与红细胞（RBC）的最佳比例，并评价其预后。【方法】选择2014年6月至2017年6月本院收治的120例急性上消化道出血患者作为研究对象。根据FFP与RBC的输血比例分组，将37例FFP：RBC〉1：1记为A组；将45例FFP：RBC≥1：2，且≤1：1记为B组；将38例FFP：RBC〈1：2记为C组。比较三组FFP和RBC使用量、血常规、凝血功能、电解质指标变化、输血不良反应及预后情况。【结果】三组FFP和RBC使用量对比差异均有统计学意义（P〈0．05），组间对比差异也均有统计学意义（P〈0．05），其中A组FFP使用量最高、B组稍低、C组最低，B组RBC使用量最高、A组稍低、C组最低。输血后三组血常规、凝血功能指标、Ca^2＋水平差异均有统计学意义（P〈0．05）；组间比较，C组血红蛋白（Hb）、血小板（PLT）、国际标准化比值（INR）明显高于A组和B组（P〈0．05），凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）明显长于A组和B组（P〈0．05），且A组INR明显高于B组（P〈0．05），PT和APTT明显长于B组（P〈0．05），B组Ca^2＋水平均明显低于A组和C组（P〈0．05）；输血后三组Hb、Ca^2＋水平均降低（P〈0．05），A组和C组PLT均降低（P〈0．05），PT和APTT均延长（P〈0．05），INR均升高（P〈0．05）。A组、B组和C组总输血不良反应发生率分别为5．41％、0．00％、2．63％，差异无统计学意义（P〉0．05）；三组总不良预后发生率分别为21．62％、2．22%、15．79％，B组明显低于A组和C组（P〈0．05）。【结论】急性上消化道出血患者不同FFP与RBC比例可影响血常规、凝血功能和电解质指标，建议保持FFP：RBC≥1：2，且≤1：1，能够显著减少预后不良事件。

[Objective]To explore optimal proportion of plasma （FFP） and red blood cell （RBC） in patients with acute upper gastrointestinal bleeding and to evaluate the prognosis.[Methods]The clinical data of 120 patients with acute upper gastrointestinal bleeding in our hospital from June 2014 to June 2017 were retrospectively ana- lyzed. According to the proportion of blood transfusion in FFP and RBC, 37 cases of FFP ： RBC 〉1 ： 1 were re- corded as group A, 45 cases of FFP ： RBC more than or equal to 1 ： 2, and less than or equal to 1 ： 1 were recor- ded as B group, and the other 38 cases of FFP：RBC 〈 1：2 were recorded as group C. The use of FFP and RBC, blood routine, blood coagulation, changes in electrolyte indicators, adverse effects of blood transfusion and prog- nosis were compared. [Results]The differences of the use of FFP and RBC in the 3 groups was statistically signifi- cant （ P 〈 0.05）, which were also statistically significant between each two groups （ P〈0.05）. The use of FFP in the group A was the highest, the B group was a little lower and the C group was the lowest. The use of RBC in the group B was the highest, the A group was a little lower, and the C group was the lowest. The differences of blood routine, blood coagulation function index and Ca2＋ levels among the 3 groups after blood transfusion were statistically significant （ P〈0.05）. Compared among the groups, Hb, PLT and INR in group C were significantly higher than those in the group A and the group B （P〈0.05）, and the PT and APTT were significantly longer than those of the group A and B （ P 〈0.05）, and the INR in the group A was significantly higher than that in the group B （ P〈0.05）, and the levels of PT and APTT were significantly longer than those in the group B （ P〈0.05）. The level of Ca2＋ in the group B was significantly lower than those of the group A and C group （ P〈0.05）. After transfusion, the levels of Hb and Ca2＋ in the 3 groups were all decreased （ P〈0.05）, and the levels of PLT in the group A and C decreased （ P〈0.05）, the levels of PT and APTT were prolonged （ P〈0.05）, INR in-creased （ P 〈0.05）. The incidences of total adverse reactions of blood transfusion in the group A, the group B and the C group were 5.41%, 0.00%, 2.63%, respectively, without statistically significant differences （P〉 0.05）. The incidences of total poor prognosis in the 3 groups was 21.62%, 2.22%, 15.79%, respectively, of which the group B was significantly lower than that of the group A and C （ P 〈0.05）. [Conclusion]Patients with different FFP and RBC ratios can affect the function of blood clotting and electrolyte of acute upper gastrointestinal bleeding, and it is recommended to maintain FFP：RBC more than or equal to 1：2 and less than or equal to 1 ： 1, which can significantly reduce adverse events and improve the prognosis.